<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803958
Report Date: 06/10/2021
Date Signed: 06/10/2021 02:14:10 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:REDWOOD SANTA ROSAFACILITY NUMBER:
496803958
ADMINISTRATOR:CARDENAS, CRISANTEFACILITY TYPE:
740
ADDRESS:1727 BURBANK AVETELEPHONE:
(707) 542-1940
CITY:SANTA ROSASTATE: CAZIP CODE:
95407
CAPACITY:26CENSUS: 14DATE:
06/10/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Cris Cardenas (Administrator)TIME COMPLETED:
02:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Cuadra arrived unannounced for the purpose of conducting a health and safety check on residents in care. LPA were greeted by Administrator, Cris Cardenas. LPA attempted to speak with Licensee, Anthony Barbato. However, he was not available by phone. Long Term Care Ombudsman, Deb Jackson was present at the time of visit. Case Management visit is being conducted at relocation site due to facility engaging their emergency plan. Emergency plan was implemented due to County Order and current plumbing issue at facility.

LPA/Administrator toured resident’s rooms and observed arrangements, toxins and medications. Relocation site does not offered meals. Per Administrator, responsible parties were notified about the relocation site. Administrator agreed to submit daily Line List of residents in the morning and afternoon indicating resident locations, current staffing schedule, written plan for medications and meals to be handled for residents in care. Administrator agrees to ensure adequate staffing at all times to meet resident care and supervision needs. A meeting will be held with Corporate members to discuss the future operation of the facility.

No deficiencies cited in the areas observed.

SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1